Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
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PROC-CODE DESC MAC BEG END<br />
66940 EXTRACTION OF LENS WITH OR WITHOUT IRIDECTOMY $534.71 20060701 99999999<br />
66982<br />
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF<br />
INTRAOCULAR LENS PROSTHESIS (ON $778.50 20060701 99999999<br />
66983 INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF $494.28 20060701 99999999<br />
66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF $584.09 20060701 99999999<br />
66985 INSERTION OF INTRAOCULAR LENS SUBSEQUENT TO CATARACT $484.39 20060701 99999999<br />
66986 EXCHANGE OF INTRAOCULAR LENS $673.14 20060701 99999999<br />
67005<br />
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY<br />
TECHNIQUE $306.43 20060701 99999999<br />
67010<br />
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY<br />
TECHNIQUE $369.97 20060701 99999999<br />
67015 ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR $416.20 20060701 99999999<br />
67025 INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA APPROACH $411.60 20060701 99999999<br />
67027<br />
IMPLANTATION OR REPLACEMENT OF INTRAVITREAL DRUG DELIVERY<br />
SYSTEM (EG, GANCICLOVI $590.72 20060701 99999999<br />
67028<br />
INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE<br />
PROCEDURE) $135.55 20060701 99999999<br />
67030<br />
DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS<br />
PLANA $318.92 20060701 99999999<br />
67031<br />
SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS,<br />
SHEETS, $181.47 20060701 99999999<br />
67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $821.70 20060701 99999999<br />
67038 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $1,209.64 19990701 99999999<br />
67039<br />
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL<br />
ENDOLASER PHOTOCOAGULATI $847.98 20060701 99999999<br />
67040 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $1,214.68 20060701 99999999<br />
67041<br />
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL<br />
OF PRERETINAL CELLULAR $595.81 <strong>200801</strong>01 99999999<br />
67042<br />
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL<br />
OF INTERNAL LIMITING M $680.36 <strong>200801</strong>01 99999999<br />
67043<br />
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH REMOVAL<br />
OF SUBRETINAL MEMBRANE $715.45 <strong>200801</strong>01 99999999<br />
67101 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $406.49 20060701 99999999<br />
67105 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $365.66 20060701 99999999<br />
67107 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $881.22 20060701 99999999<br />
67108 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $1,430.57 20060701 99999999<br />
67110<br />
REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; BY<br />
INJECTION OF AIR OR OTHER $555.94 20060701 99999999<br />
67112 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS $976.62 20060701 99999999<br />
67113<br />
REPAIR OF COMPLEX RETINAL DETACHMENT (EG, PROLIFERATIVE<br />
VITREORETINOPATHY, STAGE $718.34 <strong>200801</strong>01 99999999<br />
67115 RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT) $326.30 20060701 99999999<br />
67120 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT $378.24 20060701 99999999<br />
67121 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT $627.47 20060701 99999999<br />
67141<br />
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK,<br />
LATTICE $290.59 20060701 99999999<br />
67145<br />
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK,<br />
LATTICE $266.00 20060701 99999999<br />
67208 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, $350.59 20060701 99999999<br />
67210 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, $408.38 20060701 99999999<br />
67218 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, $793.79 20060701 99999999<br />
67220<br />
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL<br />
NEOVASCULARIZATION), O $564.34 20060701 99999999<br />
67221<br />
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL<br />
NEOVASCULARIZATION); P $216.25 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 220